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NPI Code Detail

MEDICARE: DR. MELANIE G RUSHING O.D.

MEDICARE: DR. MELANIE G RUSHING O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist06251TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
206251TGOTHERTXSTATE LICENSE

General Provider Information

NPI Number : 1770572703
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELANIE G RUSHING O.D.
Provider Business Mailing Address
First Line : PO BOX 632600
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75963-2600
Country : US
Telephone Number : 936-564-7661
Fax Number : 936-564-6622
Provider Business Practice Location Address
First Line : 3208 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2633
Country : US
Telephone Number : 936-564-7661
Fax Number : 936-564-6622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 05/23/2011

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